UCHA Application Form

Application Form

Instructions:

Step 1 - Please fill-out the under mentioned information which will automatically be transferred into the official application form. Double check your information for accuracy before submitting Please also note the following:

Fields marked with an asterisk (*) are required.

Social Security # is required only if the Country of Birth or Citizenship is United States (USA).

Step 2 - Please print the PDF form, sign and date in all places where it states 'Signature and Date' before sending it to the UCHA.

Parents:

References:

Previous landlords in whose apartments you have lived within the last 3 years. Do not list relatives.

Reference 1

Reference 2

Emergency Contact:

* Name(s)

* Relationship

* Address

* Phone: Home

Phone: Work

Other Info:

* How did you learn about UCHA?

Bruin Ad
Mailing
Campus Posting
Friend
Other

* What does cooperative living mean to you?

* Have you ever been convicted of a felony or misdemeanor?

No
Yes

* Have you lived here before?

No
Yes
Were you expelled/Evicted?

* Have you applied to UCHA before (for housing)?

No
Yes

* Have you been evicted by a previous landlord?

No
Yes

Payment Authorization:

Visa/MasterCard #

Amount

Expiry

Security Code

Zip Code

Please ensure that you manually sign and date the Application Form (where it states 'Signature and Date'), before sending to the UCHA. If payment is made by credit card then sign and date in the required section as well.